As intrinsic as it may seem to cultivate humanistic skills during residency training, medical education often fails to maintain, and may even suppress, residents’ orientation to empathy and caring. The demands of residency training and its focus on fostering clinical expertise and technical skills sometimes comes at the sacrifice of nurturing compassionate care. This is an example of how residency training has the potential to hijack empathic care. Some have referred to this as the “efficiency-empathy trade-offs” that are resolved only in bartering the “time to care” for “tasks to do.”
The aim of my AMS phoenix project is to: (1) implement a comprehensive 3-year patient and family-centred longitudinal curriculum focused on social pediatrics that builds on the academics taught within the residency training program for pediatrics; and (2) examines how longitudinal approaches to curriculum support the construction of empathic, patient and family-centred physician identity among trainees.
We have recently developed and incorporated a longitudinal integrated approach to curriculum delivery within pediatric residency training that is comprised of four main learning approaches:
(1) Discursive curriculum: Residents participate in a number of academic half-day sessions throughout their 3-year training. These sessions are unique from the remainder of academic sessions as they bring together pediatricians; multidisciplinary team members; community partners; and patients and families to weave together storytelling, the humanities, and clinical skills in to the delivery of teaching.
(2) Community-based learning experiences: Residents participate in required clinical experiences situated within the community throughout their 3-year residency program. These community experiences have been placed within various clinical rotations to learn from patients and their families within a societal context and to further enhance the resident’s learning while working with diverse populations.
(3) Simulation Learning: Training physicians participate in social medicine-related simulation scenarios that are interwoven throughout the curriculum. The simulations include clinically challenging scenarios when empathic interactions typically break down and debriefings include examining attitudes, behaviors and communication skills from the perspective of patients and families. Patients and families play an integral role in the design of PFCC scenarios and as active participants during simulation debriefing exercises related to these scenarios to offer unique insights as to the importance of certain skills expected and appreciated by patients and families.
(4) Independent Learning: Residents participate in various independent learning activities through the completion of online modules, reviewing scholarly articles and self-reflection activities. These activities have been developed to build upon the Social Pediatrics curriculum presented within the discursive curriculum and are integrated in to clinical rotations to enhance hands-on learning. A particular focus of this curriculum has included self-reflection and addressing the attitudes and biases of training physicians.
Social Pediatrics is an essential part of residency training; however there is very little literature that addresses how such a broad-ranging topic can be taught effectively and its impact on physician identity (van den Heuvel, Meta; et. al., 2017). In this regard, we are currently working to develop measures that will evaluate the longitudinal integrated approach we have taken to delivering the curriculum. We are also currently working to develop a multi-dimensional approach to assessing resident’s learning that is complementary to the new CanMED framework.
Through this project work, my hope is to create an inspiring curriculum in which resident’s orientations through their medical training are transformed through participation, dialogue and critical reflection. My AMS Phoenix Fellowship has given me the opportunity through dedicated time and a like-minded community to see this project come to realization.
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